Tackling visibility: towards developing a protocol for voice and communication therapy for trans men from of a pilot study undertaken between Charing Cross Gender Identity Clinic, London and the Laurels Clinic of Gender and Sexual Medicine, Exeter, UK

A number of studies have documented the effects of masculinising hormones on voice in FtM transsexuals (trans men) (Adler, Constansis, & van Borsel, 2012; Damrose, 2009; Zimman, 2010). Despite evidence that taking androgens... [ view full abstract ]

A number of studies have documented the effects of masculinising hormones on voice in FtM transsexuals (trans men) (Adler, Constansis, & van Borsel, 2012; Damrose, 2009; Zimman, 2010). Despite evidence that taking androgens lowers the Speaking Fundamental Frequency, trans men often report a difference between habitual pitch and ‘passing pitch’ (Davies, Papp & Antoni, 2015) and find they continue to be vocally misgendered well into their testosterone treatment (Solderpalm et al., 2004). There is a scarcity of research on voice and communication therapy for trans men, and increasing the clinical evidence base may highlight the potential benefits of accessing voice therapy. A joint project was carried out between two UK Gender Identity Clinics to  was offered to a group of 9 trans men within the context of their on-going psychological and investigate the benefits of group therapy within the contexts of ongoing psychological and psycho-social treatment and support. The project consisted of a pilot group workshop and a second programme of two 3-hour workshops, one month apart.

An initial pilot workshop aimed to explore whether a protocol of voice education, vocal training and practice would impact on the clients' own perception and overall rating of the ‘maleness’ of their voice and their... [ view full abstract ]

An initial pilot workshop aimed to explore whether a protocol of voice education, vocal training and practice would impact on the clients' own perception and overall rating of the ‘maleness’ of their voice and their ability to use a number of voice qualities and parameters. Findings were used to refine a protocol for a second group programme, consisting of two workshops one month apart.

Speaking and Reading Fundamental Frequencies (SFF and RFF) were gathered at the beginning of the pilot group, and at the beginning and end of the second group. Participants completed a ‘Self-Perception of Voice and... [ view full abstract ]

Speaking and Reading Fundamental Frequencies (SFF and RFF) were gathered at the beginning of the pilot group, and at the beginning and end of the second group. Participants completed a ‘Self-Perception of Voice and Communication’ questionnaire, which had been developed in consultation with service users prior to the commencement of the workshops. The questionnaire was repeated at the end of the workshops which involved topics of voice education, vocal hygiene, and identity and authenticity. Practical exercises focussed on voice onset and quality, resonance, loudness and intonation, and extended into speaking and conversation. 

Participant perception was rated by a ‘Self-Perception of Voice & Communication’ questionnaire. The initial questionnaire consisting of 6 questions on the use, function and perception of voice, was refined for the second... [ view full abstract ]

Participant perception was rated by a ‘Self-Perception of Voice & Communication’ questionnaire. The initial questionnaire consisting of 6 questions on the use, function and perception of voice, was refined for the second programme .

All participants reported a positive shift in the self-rating of their voice at the end of the workshop. Following the pilot workshop, 67% of participants reported that their ability to adapt the quality of their voice was... [ view full abstract ]

All participants reported a positive shift in the self-rating of their voice at the end of the workshop. Following the pilot workshop, 67% of participants reported that their ability to adapt the quality of their voice was less restricted; 33% remained the same. It is hypothesised that final evaluation of the second programme will yield similar encouraging results.

Exploration of voice and communication skills addressing vocal fatigue, voice-body connection, resonance, and pitch and loudness dynamics, contributed to trans men’s perception of their voice as being more male. This... [ view full abstract ]

Exploration of voice and communication skills addressing vocal fatigue, voice-body connection, resonance, and pitch and loudness dynamics, contributed to trans men’s perception of their voice as being more male. This study contributes to a currently scarce literature suggesting which parameters might need to be included in a voice therapy protocol for trans men to facilitate self-assessment of a more authentic voice perceived as more congruent with their gender identity.



Adler, R. K., Constansis, A. N., & van Borsel, J. (2012). Female-to-male considerations. In R. K. Adler, S. Hirsch, & M. Mordaunt (Eds.), Voice and communication therapy for the transgender/transsexual client:(2nd ed., pp. 153– 187). San Diego, CA: Plural.

Damrose, E. J. (2009). Quantifying the impact of androgen therapy on the female larynx. Auris, Nasus, Larynx, 36(1), 110–112.

Davies, S., Papp, V.G., & Antoni, C. (2015) Voice and Communication for gender nonconforming individuals International Journal of Transgenderism 16 (3),117-159.

Soderpalm, E., Larsson, A., & Almquist, S.A. (2004). Evaluation of a consecutive group of transsexual individuals referred for vocal intervention in the west of Sweden. Logopedics, Phoniatrics, Vocology, 29 (1), 18–30.

Zimman, L. (2010). Female-to-male transsexuals and gay-sounding voices: A pilot study. Colorado Research in Linguistics, 22, 1–21.